الفهرس 
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Abstract
The present study was aiming to give a detailed anatomical and radiological description of the sacrotuberous ligament (STL) and its relation to low back pain (LBP) and sacroiliitis.
In the cadaveric study, 40 adult male hip, gluteal and upper thigh specimens were used. 20 of them were formalin fixed and the other 20 were fresh frozen specimens. They were dissected to fully expose the STL and its related structures. The ligament was divided into 3 limbs: 2 Attached limbs: one extending from posterior superior iliac spine (PSIS) to the back of S3 and measured 20mm-35mm in formalin fixed specimens and from 32.9mm-44mm in fresh frozen specimens, and the other one was extending from the back of S3 to the back of S5 and the back of the coccyx and measured 28.1mm-38.4mm in formalin fixed specimens and from 35.2mm-45mm in fresh frozen specimens. The third limb is a free limb extending from S5 and the coccyx to midpoint of the medial margin of the ischial tuberosity which was ranging from 38.2 mm to 56.9 mm in formalin fixed specimens and from 42.3 mm to 77 mm in fresh frozen specimens.
In dissection, the fibers of the STL showed a variation in direction from fanning at the upper part to twisting at the lower part while approaching the ischial tuberosity till forming a sickle shaped falciform ligament at the ischial ramus.
STL was found to blend with neighboring ligaments like the long dorsal sacroiliac ligament and tension in one of them affects in sequence the other, the joint stability and consequently weight transmission through the sacroiliac joint (SIJ). The STL was seen to blend partially with the sacrospinous ligament (SSL) to form the greater and the lesser sciatic foramina and both ligaments are of oppositional effect on the pelvis.
The STL was also found to give attachment to important muscles such as gluteus maximus muscle which is attached to the ligament in oblique manner producing different lines of force transmission. Dissection of the biceps femoris-semitendenosus conjoint tendon in the present study detected its continuity by itself and by its fascia to the STL. So, hamstring injury may affect the ligament and subsequently the SIJ biomechanics.
In the current work, STL was seen related to pudendal nerve as it traverses the pudendal canal between STL and SSL. So, STL is involved in pudendal entrapment syndrome and can be a treatment approach. The STL is also related to sciatic nerve and the proximity between them was determined by the width of the free limb of the ligament but the exact connection between them and the ligamentous involvement in sciatica is still not well justified.
In the radiological study, 35 pelvic CT scans were collected from adult male patients ranging from 20-40 years old. The free limb of the STL was visualized by using Multi Planner Reconstruction (MPR) technique. They were divided into 3 groups and the length of the of the STL was measured in each group:
In group (A): (patients without LBP nor sacroiliitis), the SIJ showed normal edges and joint space and the STL was uniform in shape with average length 47.4mm.
In group (B): (patients with LBP not associated with sacroiliitis), the SIJ showed normal appearance and the STL was uniform in shape with average length 51.9 mm. (Both groups A and B were considered control groups)
In group (C): (patients with LBP and sacroiliitis), the SIJ showed signs of inflammation as vacuum phenomenon, narrowing of joint space, subchondral sclerosis and cysts and was consequently subdivided into 2 subgroups:
In group (C-): the STL was uniform in shape with noticeable but non-significant increase in its length to an average of 59.6 mm.
In group (C+): the STL showed different degrees of redundancy with significant increase in length to an average of 69.3 mm.